Normative Values for the Unipedal Stance Test
with Eyes Open and Closed
COL Barbara A. Springer, PT, PhD, OCS, SCS¹; COL Raul Marin, MD¹; Tamara Cyhan, RN, BSN¹;
CPT Holly Roberts, MPT, GCS¹; MAJ Norman W. Gill, PT, DSc, OCS, FAAOMPT¹
¹ Department of Orthopedics and Rehabilitation, Walter Reed
Army Medical Center, Washington, DC
ments that in whole or in part accounted for variation in length
of stay and functional independence measure scores.1 Balance
impairment is highly prevalent in patients with head injuries,
peripheral neuropathy, or vestibular disorders.2-15 Tjon et al documented postural instability in patients with rheumatoid arthritis while others have shown that a relationship exists between
age and sway, with sway increasing after age 40.16-20 Balance
is not only affected in those with disease processes or trauma.
Balance disturbances have also been documented in healthy
senior citizens.21-24 Investigators have found a direct relationship between abnormal tests of balance and unexplained falls
in older adults.24-26
For the main types of balance (static postural control,
dynamic- anticipatory, and reactionary- postural control) there
are numerous clinical tests to assess performance. The timed
unipedal stance test (also referred to as timed single limb stance,
unipedal balance test, one leg stance test, and one-leg standing
balance) is a simple test for measuring static aspects of balance
that can be used in a variety of settings and requires minimal
equipment or training. Abnormal unipedal stance test (UPST)
time with the eyes open is related to conditions such as peripheral neuropathy and intermittent claudication.9-11,27 Decreased
eyes open UPST time is also associated with an increased risk
for falls.8,21,22,24,26-30 Further, the UPST conducted with eyes closed
may yield other valuable information. Since patients with medical conditions that impair balance may rely heavily on vision to
maintain their balance, it is possible that these patients would
be at an increased risk for falls in conditions where visual input
is inaccurate or eliminated, such as nighttime ambulation.
The UPST is described as a method of quantifying static balance ability.31 It is a valid measure32 and is useful in explaining
other variables of importance such as frailty and self-sufficiency
in activities of daily living,22,33 gait performance,34,35 and fall
status.36 Jacobs et al recommended including the UPST with
the eyes open in conjunction with several tests for patients
with Parkinson disease in order to evaluate postural stability
because it correlated with balance confidence and a history of
falls.37 El-Kashlan et al recommended using the test as an outcome measure of static equilibrium for clinical trials of vestibular treatment.38 The UPST with the eyes open, but not closed,
is also reliable for testing health-related fitness.39 Potvin and
Tourtellotte recommended that UPST with the eyes closed be
documented in conjunction with a battery of tests to evaluate
motor function during the ‘clinical quantitative neurological
examination,’ and Brinkman et al included the UPST with eyes
open in their recommended battery of tests for balance assess-
The views expressed in this article are those of the author and
do not reflect the official policy of the Department of the Army,
Department of Defense, or U.S. Government. This manuscript was
produced without any sources of support. There are no competing
interests.
ABSTRACT
Purpose: Limited normative data are available for the
unipedal stance test (UPST), making it difficult for clinicians to
use it confidently to detect subtle balance impairments. The
purpose of this study was to generate normative values for
repeated trials of the UPST with eyes opened and eyes closed
across age groups and gender. Methods: This prospective,
mixed-model design was set in a tertiary care medical center.
Healthy subjects (n= 549), 18 years or older, performed the
UPST with eyes open and closed. Mean and best of 3 UPST
times for males and females of 6 age groups (18-39, 40-49, 5059, 60-69, 70-79, and 80+) were documented and inter-rater
reliability was tested. Results: There was a significant age
dependent decrease in UPST time during both conditions.
Inter-rater reliability for the best of 3 trials was determined
to be excellent with an intra-class correlation coefficient of
0.994 (95% confidence interval 0.989-0.996) for eyes open and
0.998 (95% confidence interval 0.996-0.999) for eyes closed.
Conclusions: This study adds to the understanding of typical
performance on the UPST. Performance is age-specific and not
related to gender. Clinicians now have more extensive normative values to which individuals can be compared.
Key Words: balance testing, single limb stance, normative,
aging
INTRODUCTION
Balance impairments are a common finding among patients
experiencing disease or trauma. Juneja et al reported that
patients in acute inpatient rehabilitation who have experienced a stroke, head injury, non-orthopedic poly-trauma, or
patients who are generally deconditioned had balance impairAddress all correspondence to: COL Barbara A. Springer,
2 Greenlane Court, Potomac, MD 20854, Ph: 202-782-6371,
Fax: 202-782-3764 (Barbara.Springer@na.amedd.army.mil).
Journal of Geriatric Physical Therapy Vol. 30;1:07
Study Design
This study was a repeated measures, cross-sectional study.
From June 2004 to December 2004, a poster advertisement
describing the aims of the study was displayed in the waiting
room of the PMR, PT, and OT clinics and in the lobby at our
institution. The advertisement encouraged any healthy volunteer to contact the study research nurse who then explained
the study in detail and obtained written informed consent
which was approved by the Clinical Investigation and Human
Use Committees of the Department of Clinical Investigation at
Walter Reed Army Medical Center. The research nurse recorded
each subject’s age, gender, race, height, weight, reason for
being in the clinic, diagnosis (if any), level and location of pain
(if any), limb chosen for UPST and ‘dominant limb’ on the data
collection sheet. Before the UPST was performed, the subject
was asked to kick a ball placed on the floor in front of him and
the kicking limb was recorded as the ‘dominant’ limb. Up to 3
investigators performed the actual UPST testing and interrater
reliability testing was performed by having 2 investigators test
a subsample of 50 subjects. Both investigators used identical
digital stopwatches and tested the same subject at the same
time. An independent recorder annotated the time on their
stopwatches. The third investigator began assisting with data
collection after the first two had already finished with the interrater reliability testing.
Eligible subjects were asked to stand barefoot on the limb of
their choice, with the other limb raised so that the raised foot
was near but not touching the ankle of their stance limb. Each
subject was asked to focus on a spot on the wall at eye level in
front of him, for the duration of the eyes open test. Prior to raising the limb, the subject was instructed to cross his arms over
the chest. The investigator used a stopwatch to measure the
amount of time the subject was able to stand on one limb. Time
commenced when the subject raised the foot off the floor. Time
ended when the subject either: (1) used his arms (ie, uncrossed
arms), (2) used the raised foot (moved it toward or away from the
standing limb or touched the floor), (3) moved the weight-bearing foot to maintain his balance (ie, rotated foot on the ground),
(4) a maximum of 45 seconds had elapsed, or (5) opened eyes
on eyes closed trials. The procedure was repeated 3 times and
each time was recorded on the data collection sheet. The best
and the average of the 3 trials were also recorded. Subjects
performed 3 trials with the eyes open, and 3 trials with the eyes
closed, alternating between the conditions. For example, 1 trial
with eyes open followed by 1 trial with eyes closed equaled 1
trial set. The order of testing was randomized based on odd or
even last digit in social security number. At least 5 minutes of
rest were allowed between each trial set to avoid fatigue. Data
collection sheets were summarized into the 8.0 release of SPSS
for Windows (SPSS Inc., Chicago, Ill).
ment in a routine neurological examination.40,41 Curb et al also
recommended the ‘unassisted single-leg stand’ in a battery
of tests to quickly assess global functional level, which adds
to the validity of the measure and its usefulness in explaining
other variables of importance.42
There are many other examples of how impaired UPST time
is related to a variety of balance impairments. When combined
with time to walk 1 meter and self-report of changed mobility
status, the UPST can be used to identify preclinical disability in
community-dwelling women and to screen higher-functioning
populations for impairments.43 Vellas et al found that subjects
who were unable to balance on one limb for 5 seconds had 2.1
times the risk of incurring an injurious fall as individuals who
could balance for more than 5 seconds.36 Gehlsen and Whaley
were able to distinguish between fallers and nonfallers using
the UPST with eyes open and eyes closed in an elderly population.44 Also, the authors of 2 studies suggested that impaired
UPST is a marker of frailty in elderly persons.22,33
Even though the UPST appears to be used often in clinical
settings to test static balance for a variety of reasons, limited
normative data for the eyes open and closed conditions have
been established with which to compare the tested values.20,38,39,44-46 Some of the limitations of these studies include
no reported age groups, the UPST not reported separately from
a test battery, and small sample sizes.20,38,39,44-46 Limited normal
values make it difficult for clinicians to use their measurements to detect subtle neurological or vestibular impairments.
Further, establishing more extensive normative values by age
group and gender would also offer clinicians and patients realistic goals to reach during a rehabilitation program. Therefore,
the purpose of this study was to document normative values
for the UPST with eyes open and closed in a large population
by age and gender to serve as an acceptable reference standard. Our research hypothesis was that UPST would decrease
as age increased.
METHODS
Subjects
Volunteers were healthy military health care beneficiaries,
ages 18 and older, recruited from among the staff members,
patients, and patient family members who worked in or presented to the Physical Medicine and Rehabilitation (PMR),
Physical Therapy (PT), and Occupational Therapy (OT) clinics
located in a tertiary care United States military medical center.
Data were collected during a 7-month period from a convenience sample of 567 consecutive volunteers. Subjects were
excluded from participation if they had a known history of balance impairment (for any reason); peripheral neuropathy (clinically diagnosed or if they had symptoms of numbness/tingling
in the lower extremities); orthopedic lower extremity or lumbosacral conditions requiring consultation with a health care
professional (to include ligamentous injuries, osteoarthritis, or
joint replacement); pain of any level presenting simultaneously
in both lower extremities; or unilateral lower extremity pain >3
on the 11 point visual analog (box) scale. Pregnant women
were also excluded.
Journal of Geriatric Physical Therapy Vol. 30;1:07
Sample Size Estimation
In a statistical analysis of methods to determine sample sizes
for deriving reference values for an electrical diagnostic test,
Chang et al concluded that the optimally efficient sample size is
approximately 100 per group.47 For a sample size less than 100,
the mean square errors were substantially increased. Based on
this information, we aimed at a sample size of 30 to 50 subjects
per gender per age group. Given that the study had 6 age
groups (18-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79
years, and 80-99 years), we aimed at a total sample size of up
to 600 subjects.
Statistics
The best and mean of 3 trials were taken for each subject for
the eyes open and eyes closed condition. Descriptive statistics
were calculated for the best and mean UPST for both genders
within all 6 age groups for both the eyes open and eyes closed
condition. Common statistical criteria defined the reference
range for normals as the mean ± 2 standard deviations. The
best and mean UPST times were used for inferential statistical analysis. A 2 x 2 x 6 mixed model ANOVA with gender and
age group as fixed factors and test condition (eyes open, eyes
closed) as a repeated factor was calculated to identify a 3 factor
interaction. Post-hoc 2 way ANOVAs were then calculated to
analyze interactions present; 2 x 2 mixed model ANOVAs were
calculated for gender versus testing condition, 2 x 6 mixed
model ANOVAs were calculated for testing condition versus
age group, and 2 x 6 fixed factor ANOVAs were calculated for
gender versus age group. One way ANOVAs for each testing
condition along with Tukey’s HSD were used to determine specific differences between age groups. Alpha was set at 0.05 and
was appropriately corrected for multiple tests. Inter-rater reliability analysis was conducted using the intraclass correlation
coefficient (ICC) and 95% confidence intervals. The ICC (2,1)
was used for the best of 3 trials score and ICC (2,k) was used
for the mean of 3 trials. The ICCs were calculated for both eyes
open and eyes closed conditions.
RESULTS
A total of 567 participants consented to participate in the
study. Of these, 18 were dropped from the sample because of
the following reasons: 3 had pain > 3 on visual analog scale
while standing on 1 limb, 4 had to leave prior to completion
of testing, 1 had shoes on, 1 was too tired, 1 was younger than
18 years, and the remaining 8 belonged to an age group that
had already filled its allocated quota. The final number of participants included in the analyses was 549 (female 258, 47%;
male 291, 53%). The subcategories of participants were: 238
(43.4%) were patients, 135 (24.6%) were family members of
patients, 39 (7.1%) were staff, 32 (5.8%) were soldiers, 27 (4.9%)
saw the advertisement, and 78 (14.2%) were other. The ethnic
mix of the study sample consisted of 339 (61.7%) Caucasians,
135 (24.6%) African American, 44 (8.0%) Hispanic, 18 (3.3%)
Asian, and 13 (2.4%) were other. Mean height (SD) was 66.9
(6.3) inches and mean weight (SD) was 172.3 (43.7) pounds.
Forty-three (7.8%) subjects reported pain in a lower extremity
and 10 (1.8%) reported back pain. Level of pain for these areas
(on a visual analogue pain scale of 0-10) ranged from 0-3 (mean
2.2, SD 0.90). Only 57.7% of the participants chose to stand on
their right limb even though 89.4% were right limb dominant
as demonstrated by the limb with which they kicked the ball.
Table 1 provides the best and mean UPST times for females
and males with eyes open and eyes closed for the 6 age groups
as well as the values for females and males independent of age.
Though a few cells show a skewed distribution due to a ceiling
or floor effect, the data as a whole is normally distributed, therefore we proceeded with parametric analysis. For the inferential
statistics, we report only the results of the best since that is how
the test is used clinically. Further, we draw the same conclusions from the data whether the best or the mean of 3 trials is
used. The 2 x 2 x 6 mixed model ANOVA showed a 3 way interaction of the factors (F=2.97, p=0.01). Post hoc 2 way ANOVAS
(group vs. test, gender vs. test, and group vs. gender) revealed
only one significant interaction (group vs. test; F=32.52, p <
0.001) which contributed to the overall significance of the 3
way ANOVA. However, Figure 1 shows the interaction to be an
ordinal interaction. Therefore, appropriate interpretation of the
main effects demonstrates a significant main effect for both
test condition (F=1545.89, p < 0.001) and age group (F=109.31,
p < 0.001). The 2 x 2 mixed model ANOVA (gender versus test
condition) demonstrated no interaction (F=0.04, p = 0.84), a
significant main effect for test condition (F=1393.70, p < 0.001),
and no significant difference for gender (F=0.23, p=0.64). 2 x 6
fixed factor ANOVAs demonstrated no significant interactions
(F=2.52, p=0.028 eyes open; F=1.47, p=0.119 eyes closed) at a
corrected alpha of 0.025. There were significant main effects
for age category (F=97.26, p < 0.001 for eyes open; F=31.57,
p < 0.001 for eyes closed) and no significant main effects for
gender (F=2.53, p=0.112 for eyes open, F=0.425, p=0.515 for
eyes closed). One way ANOVAs for group differences demonstrated statistical significance for both eyes open (F=98.71, p <
.001) and eyes closed (F=32.17, p < 0.001) and Tukey’s post-hoc
comparisons revealed multiple group differences (Table 2).
Inter-rater reliability testing on a subgroup of 50 participants demonstrated ICC=0.994 (95% confidence interval 0.989
to 0.996) for eyes open best of 3 trials, ICC=0.998 (95% confidence interval 0.996 to 0.999) for eyes closed best of 3 trials,
ICC=0.951 (95% confidence interval 0.926 to 0.969) for eyes
open mean of 3 trials, and ICC=0.832 (95% confidence interval
0.748 to 0.895) for eyes closed mean of 3 trials.
DISCUSSION
Our results confirm our hypothesis that there is a significant
age dependent decrease in the ability to stand on 1 limb with
both the eyes open and eyes closed UPST. In addition, the high
inter-rater reliability supports the use of the UPST as a clinical
screening tool and/or outcome measure for rehabilitation.
Normative data are helpful in setting goals against a mean performance standard specifically representative of the patient.
Additionally, a score that lies 1 to 2 standard deviations below
the mean, in the context of the rest of the subjective or objective examination, may indicate a possible balance impairment
that may require further clinical investigation with other confirmatory or complementary tests.
We found that the difference in UPST times is not gender
specific but is related to age, with the eyes open condition
always resulting in significantly longer UPST times than eyes
10
Journal of Geriatric Physical Therapy Vol. 30;1:07
Table 1. Unipedal Stance Test Time by Age Group and Gender for Eyes Open and Closed
Age & Gender
Eyes Open Best of
Eyes Open Mean
Eyes Closed Best
Groups
3 trials (sec)
of 3 trials (sec)
of 3 trials (sec)
Mean (SE)
Mean (SE)
Mean (SE)
Eyes Closed Mean
of 3 trials (sec)
Mean (SE)
18-39
Female (n = 44)
Male (n = 54)
Total (n = 98)
45.1 (0.1)
44.4 (4.1)
44.7 (3.1)
43.5 (3.8)
43.2 (6.0)
43.3 (5.1)
13.1 (12.3)
16.9 (13.9)
15.2 (13.3)
8.5 (9.1)
10.2 (9.6)
9.4 (9.4)
40-49
Female (n = 47)
Male (n = 51)
Total (n = 98)
42.1 (9.5)
41.6 (10.2)
41.9 (9.9)
40.4 (10.1)
40.1 (11.5)
40.3 (10.8)
13.5 (12.4)
12.0 (13.5)
12.7 (12.9)
7.4 (6.7)
7.3 (7.4)
7.3 (7.0)
50-59
Female (n = 50)
Male (n = 48)
Total (n = 98)
40.9 (10.0)
41.5 (10.5)
41.2 (10.2)
36.0 (12.8)
38.1 (12.4)
37.0 (12.6)
7.9 (8.0)
8.6 (8.8)
8.3 (8.4)
5.0 (5.6)
4.5 (3.8)
4.8 (4.8)
30.4 (16.4)
33.8 (16.0)
32.1 (16.2)
25.1 (16.5)
28.7 (16.7)
26.9 (16.6)
3.6 (2.3)
5.1 (6.8)
4.4 (5.1)
2.5 (1.5)
3.1 (2.7)
2.8 (2.2)
16.7 (15.0)
25.9 (18.1)
21.5 (17.3)
11.3 (11.2)
18.3 (15.3)
15.0 (13.9)
3.7 (6.2)
2.6 (1.7)
3.1 (4.5)
2.2 (2.1)
1.9 (0.9)
2.0 (1.6)
10.6 (13.2)
8.7 (12.6)
9.4 (12.8)
7.4 (10.7)
5.6 (8.4)
6.2 (9.3)
2.1 (1.1)
1.8 (0.9)
1.9 (1.0)
1.4 (0.6)
1.3 (0.6)
1.3 (0.6)
33.0 (16.8)
33.8 (17.1)
33.4 (16.9)
29.2 (17.4)
30.2 (17.7)
29.8 (17.5)
7.7 (9.6)
8.2 (10.8)
8.0 (10.3)
4.7 (6.0)
4.9 (6.4)
4.9 (6.2)
60-69
Female (n = 50)
Male (n = 51)
Total (n = 101)
70-79
Female (n = 45)
Male (n = 50)
Total (n = 95)
80-99
Female (n = 22)
Male (n = 37)
Total (n = 59)
Total (all ages)
Female (n=258)
Male (n = 291)
Total (n = 549)
closed. This relationship between age and balance was also
confirmed by Bohannon’s meta-analysis of single limb stance
times with eyes opened.32 Our study helps establish typical
performance values per respective age group for the eyes
closed UPST and establishes more in-depth normative values
for the eyes open UPST compared to previous studies.9,11,20,24,29
Our results are in general agreement with these investigators,
however, the limited number of subjects in their reports limits
their use as true normative values.
Balance evaluation has importance as it pertains to safety of
ambulation and transfers due to a direct relationship between
balance test abnormalities and falls.24, 26 Furthermore, balance
impairments have been shown to increase inpatient lengths
of stay and predict poor rehabilitation outcomes.1, 2 Clinically,
balance evaluations include tandem gait and Romberg testing,
among others. In specialized centers, posturography is also
used to test for balance impairment. However, the cost, size,
and complexity of a posturography system make it impractical
in some clinics, especially during a bedside evaluation. An alternative, the USPT, is not always used, yet it is an easy-to-perform
clinical tool for the evaluation of static postural balance disorders. The unipedal stance allows for the evaluation of stance
Figure 1. Best of three Trials Eyes Open vs. Eyes Closed
Unipedal Stance Test Time (sec).
Journal of Geriatric Physical Therapy Vol. 30;1:07
11
with the narrowest base of support and LaFont has positively
correlated the duration of unipedal stance with posturography
measured balance performance, which does measure dynamic
postural control.21,38 It is important to note that the UPST does
not measure the anticipatory postural control needed for selfinitiated limb movement or the reactionary postural control
needed to maintain balance during unexpected perturbations
or interference. The evaluation of balance with the UPST is a
logical and functional approach, since transient balancing on a
single limb is essential for normal gait and is critical for activities of daily living such as turning, stair climbing, and dressing.
Our study further validates and expands upon previously
established UPST normative values.9,11,20,24,29 In 1975, Potvin
made the unsubstantiated claim that young healthy adults
should be able to balance on 1 limb with eyes closed for 30
seconds and this arbitrary value does not take into consideration the effect of aging in balance.40 In a study evaluating
the relationship between the UPST and aging, Bohannon
obtained normative values for each decade from 20 to 79 years
of age for the eyes open and eyes closed conditions.20 In the
third and fourth decade, subjects were able to maintain the
UPST for an average of 28 to 29 seconds for both conditions.
However, from 40 to 60 years of age, the eyes closed condition
showed a decrease as compared to the eyes open condition.
The eyes open condition began to decrease at age 60, and a
disproportionately larger decrease occurred in the eyes closed
condition. In our study, Figure 1 clearly shows that UPST time
decreases in both conditions, with the eyes open condition
dramatically starting to decrease by the 7th decade. This is
similar to Bohannon et al’s findings for the eyes open condition.20 However, the current study differs from Bohannon and
colleagues as it pertains to the eyes closed condition, where
our results show a fairly steady decrease in UPST time occurred
across the different age groups.
The difference between the current findings and those of
Bohannon et al is underscored by their conclusion that the
data were insufficient to classify the results as true normative
values.20 Their conclusions can be explained by the fact that (1)
the authors did not randomize the testing sequence of the eyes
open and closed conditions, (2) they did not account for the
possible effect of lower extremity muscle fatigue after 5 trials
of eyes closed testing, (3) they did not account for possible substitution efforts in maintaining balance with arm movements
during testing (we required patients to keep arms crossed over
their chests during testing), and (4) they stopped UPST testing
after 30 seconds.20 In our study, we followed the methods and
rationale of Hurvitz et al by using a 45 second UPST time limit
to allow for less ceiling effect and a more normal distribution
of times.11 The age of the subjects in Bohannon et al’s study
reached 79 where as in the current study it was 99.20 Another
advantage of our study over previous work was our very large
sample size–over twice as many subjects as in the Bohannon
et al study.20
The current findings further define the normative values
of the eyes open and eyes closed conditions of the UPST and
demonstrate a significant age dependent decrease in the abil
ity to stand on 1 limb with both the eyes open and eyes closed
UPST. There are possible explanations for the age dependent
decrease in UPST times. Jonsson et al identified 2 distinct postural phases that are necessary to perform single leg stance.48
During the dynamic phase, there was a rapid decrease of force
variability amplitude as the subjects made postural adjustments
to regain standing balance after transferring weight to one
leg. The change in force amplitude occurred within the first 5
seconds of testing. During the second phase, static postural
equilibrium was required to maintain balance on one foot, and
the force variability was minimal. They concluded that elderly
subjects had difficulty maintaining balance in the static phase
due to difficulty adjusting postural control during the initial
dynamic phase of one-leg stance. Another possibility for the
decrease in stance times for elderly subjects is a decrease in
lower extremity muscular strength and endurance. Although
we did not test muscular strength or endurance in our subjects,
there is a positive relationship between hip flexor, extensor, and
abductor strength, and UPST times.46
Another measure of postural stability during single leg
stance that may contribute to decreased unipedal stance time
with increasing age is the assessment of time to boundary of
the center of pressure excursion, which is the estimated time it
would take for the center of pressure to reach the boundary of
the base of support. Although several investigators have examined time to boundary measurements in double leg stance,49-51
only preliminary data have been assessed for single leg stance.52
However, time-to-boundary measures decrease with age during
double leg stance, indicating decreased postural stability, and
may also decrease during single leg stance.49,51
Although our study provides useful findings, the following
limitations should be examined with further research. First,
although we had 59 participants in the 80 to 99 years of age
group, we did not reach our target sample size for this group.
Second, we did not allow our subjects to use their arms to
assist in maintaining balance. Elevating the arms changes the
center of mass, which can aid in postural control. However, our
testing protocol did allow for common movement strategies
in postural sway, such the ankle sway synergy (postural adjustments are made at the ankle joint), hip sway synergy (postural
adjustments are made primarily at the hip), and the suspensory
synergy (flexion at the hip, knee, and ankle to lower the center
of gravity toward the base of support).53 Third, we did not ask
information about the level of activity or fitness, which may be
an additional factor contributing to differences in performance
among groups, especially if the younger groups were relatively
more fit.
Future research may also be helpful to examine the UPST in
a subsample of subjects with known balance impairment. Also,
because the UPST tests static postural control and the ability
to transfer from a large base of support to a small base of support, further research should examine the relationship between
the eyes closed UPST and posturography, as well as whether
the UPST with the eyes open and closed is a useful test when
performed in conjunction with tests that measure dynamic
postural control such as the Functional Reach Test, Performance
12
Journal of Geriatric Physical Therapy Vol. 30;1:07
Table 2. Significant Differences in Unipedal Stance Test Times (sec) for Different Age Groups for Eyes Open and Closed
Conditions (Best of 3 Trials)
Age Groups
Eyes Condition
Significantly Different
Mean (SE) Difference
p-value
(A)
Age Groups (B)
in seconds (A-B)
18-39
40-49
50-59
Open
60-69
70-79
80-99
12.6 (1.8)
23.2 (1.8)
35.3 (2.1)
< 0.001
< 0.001
< 0.001
Closed
50-59
60-69
70-79
80-99
6.9 (1.3)
10.8 (1.3)
12.0 (1.3)
13.3 (1.5)
< 0.001
< 0.001
< 0.001
< 0.001
Open
60-69
70-79
80-99
9.7 (1.8)
20.4 (1.8)
32.5 (2.1)
< 0.001
< 0.001
< 0.001
Closed
50-59
60-69
70-79
80-99
60-69
70-79
80-99
4.5 (1.3)
8.4 (1.3)
9.6 (1.3)
10.8 (1.5)
9.1 (1.8)
19.7 (1.8)
31.8 (2.1)
0.008
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
60-69
70-79
80-99
70-79
80-99
80-99
3.9 (1.3)
5.1 (1.3)
6.3 (1.5)
10.6 (1.8)
22.7 (2.0)
12.1 (2.1)
0.030
0.001
< 0.001
< 0.001
< 0.001
< 0.001
Open
Closed
60-69
Open
70-79
Open
3.Lehmann J, Boswell S, Price R, et al. Quantitative evaluation
of sway as an indicator of functional balance in post-traumatic brain injury. Arch Phys Med Rehabil. 1990;71:955-962.
4.Newton R. Balance abilities in individuals with moderate
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Oriented Mobility Assessment, Timed Up and Go, or Dynamic
Gait Index.48,54,55 Future research should also include examination of differences in stance times between preferred and nonpreferred extremities.
SUMMARY
The performance values established in this study help make
the unipedal stance test (eyes open and eyes closed) a reliable,
readily available and easy to perform ‘bed side’ examination tool
for balance testing. These typical performance values across
a variable sample will aid clinicians in understanding the age
specific level of performance that is to be expected in healthy
individuals during UPST evaluation.
ACKNOWLEDGMENT
The authors thank Tiffany Nesfield for her assistance with
data collection. The first author had full access to all the data in
the study and takes responsibility for the integrity of the data
and the accuracy of the data analysis.
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CALL FOR NOMINATIONS FOR SECTION
ON GERIATRICS AWARDS
DEADLINE: NOVEMBER 1
AWARDS
RESEARCH AWARDS
Clinical Educator Award
This award recognizes a physical therapist or physical therapist assistant for
outstanding work as a clinical educator in the geriatric health care setting.
Adopt-A-Doc Award
The purpose of the Section on Geriatrics Adopt-A-Doc program is to provide support to doctoral students interested in pursuing faculty positions in
physical therapy education.
Clinical Excellence In Geriatrics Award
This award recognizes a physical therapist for outstanding clinical practice
in geriatric health care settings. Any current member of the Section on
Geriatrics may nominate a physical therapist who meets the award criteria.
Excellence in Geriatric Research Award
The individual nominated must be a physical therapist who has been the
author (or co-author) of a paper dealing with clinical geriatric physical therapy research. This paper must have been published in a recognized journal
(eg, Physical Therapy, Journal of American Geriatric Society, etc.) November
2002 and May 2004.
Distinguished Educator Award
The intent of this award is to recognize a Section on Geriatrics member for
excellence in teaching.
Fellowship for Geriatric Research
This Fellowship is intended to provide partial financial support to physical
therapists pursuing research in geriatrics. The research may be conducted
as part of either a formal post-entry level academic program or a mentorship
with an established investigator. The Fellowship applicant must be a physical therapist who is a current member of the Section on Geriatrics.
Joan Mills Award
This award, established in 1980 in honor of the Section on Geriatrics’ first
President, Joan M. Mills, is presented to a member who has given outstanding service to the Section.
Lynn Phillippi Advocacy for Older Adults Award
This award recognizes projects or programs in clinical practice, educational,
or administrative settings which provide strong models of effective advocacy for older adults by challenging and changing ageism. A member of
the Section on Geriatrics must nominate individuals or organizations whose
advocacy for older adults meets the intent and criteria of the award.
Student Research Award
This award is intended to facilitate interest in geriatric research among
entry-level physical therapy students. The award recognizes outstanding
research-related activity completed by entry-level physical therapy students. A member of the Section on Geriatrics must nominate the entry-level
student. The nominator will submit a letter of support which addresses
the extent of the student’s involvement in the research process (during a
period not to exceed more than 2 years of graduation from an entry-level
program).
Outstanding Physical Therapist Assistant Award
This award recognizes a physical therapist assistant who has significantly
impacted physical therapy care in geriatric practice settings. To be eligible
for this award, the nominee must be an advocate for older adults, a current
member of the Section on Geriatrics, have been involved in clinical practice
in geriatric settings for a minimum of 5 years, and demonstrate exemplary
care and innovative teamwork in meeting the physical therapy needs of
older adults.
THE DEADLINE FOR ALL AWARDS NOMINATIONS IS NOVEMBER 1,
2007. We ask that all submissions be electronic. For additional information on the criteria and selection process for section awards, please visit the
Section on Geriatrics web site at www.geriatricspt.org or contact the office
by email at geriatrics@apta.org or by phone at 800/999-2782 ext 3238.
Volunteers in Action Community Service Award
The intent of this award is to highlight the significant contributions in prevention and/or intervention for elders in typically underserved populations. This
may include, but is not limited to work with elders who are homeless, who
are homebound, live in very rural areas, live in poverty, or those of ethnic
groups facing significant cultural barriers to necessary health care.
Journal of Geriatric Physical Therapy Vol. 30;1:07
Also from the Section on Geriatrics
Consumer Brochure Contest for students.
Submissions due December 20, 2007.
*Students do not have to be APTA members.
15